Abstract

Men who have sex with men (MSM) in the US experience great disparities in health outcomes, most notably in HIV. This dissertation will take a look at these disparities and offer a framework for understanding their etiology and for understanding the processes by which these disparities are sustained, propagated and eventually broken down. First, we provide an overview of the literature regarding health disparities among MSM and the current theories that exist to understand where these disparities come from. Specifically, we focus on Syndemics Theory and the Theory of Syndemic Production as the best models for understanding health among MSM. Finally, we suggest a new theoretical model, Cultural Resilience Theory, which can be used to conceptualize health promotion within the syndemic framework. We also test components of Syndemics Theory - interaction and mediation - that until now have functioned as assumed premises with no empirical support for their assertion. Finally, we test Cultural Resilience Theory as a model that can be used in prevention programming to break down syndemic processes among MSM. In the final chapter we look into the practical implications of Cultural Resilience Theory as it applies to the prevention (or abatement) of health disparities among MSM.The findings of this study have great public health significance and important implications for HIV prevention among MSM. First, the synergism analysis is the first to test the assertion that co-occurring psychosocial health conditions interact to increase HIV risk among MSM. These results suggest that there is a synergistic effect present. Likewise, the mediation analysis is the first to test the theory of syndemic production that states that early life adversity impacts HIV outcomes through syndemic processes; an assertion that was supported by these analyses. These two studies further our understanding of how syndemics function within MSM to produce health disparities. Finally, we identify several variables that break down syndemic processes through either their negative association with poor health outcomes, or by buffering the pathways from adversity to HIV risk through syndemics. These results will provide the foundation upon which a culturally tailored Theory of Cultural Resilience among MSM can be developed.